Revive Physical Therapy and Wellness Center

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA00943300 Issued in NJ

Legal business name

REVIVE PHYSICAL THERAPY AND WELLNESS CENTER

Practice address

1941 Oak Tree Rd Ste 302
Edison, NJ 08820-2068

Phone

(732) 662-7927

Fax

(732) 662-7928

NPI assigned

Dec 8, 2008

Last updated

Dec 8, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diane Shiao, DPTNPI 1215147038

Title

PT/Owner/Director

Phone

(732) 662-7927

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Diane Shiao, DPT

  • Orthopedic Physical Therapist
  • Edison, NJ
  • NPI 1215147038
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228694400000",
    "number": "1609011493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 OAK TREE RD STE 302",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088202068",
            "telephone_number": "732-662-7927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 OAK TREE RD STE 302",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088202068",
            "telephone_number": "732-662-7927",
            "fax_number": "732-662-7928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE PHYSICAL THERAPY AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-08",
        "last_updated": "2008-12-08",
        "status": "A",
        "authorized_official_last_name": "SHIAO",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "PT/OWNER/DIRECTOR",
        "authorized_official_telephone_number": "732-662-7927",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00943300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "40QA00943300",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Brittany Richstein, LCSW, LCADC

• Physical Therapist in Edison, NJ
• Providers in Edison, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.